War’s Waste: Rehabilitation in World War I America
On the one-hundredth anniversary of World War I, it might be especially opportune to consider one of the unspoken inheritances of global warfare: soldiers who return home physically and/or psychologically wounded from battle. With that in mind, this excerpt from War’s Waste: Rehabilitation in World War I America contextualizes the relationship between rehabilitation—as the proper social and cultural response to those injured in battle—and the progressive reformers who pushed for it as a means to “rebuild” the disabled and regenerate the American medical industry.
Rehabilitation was thus a way to restore social order after the chaos of war by (re)making men into producers of capital. Since wage earning often defined manhood, rehabilitation was, in essence, a process of making a man manly. Or, as the World War I “Creed of the Disabled Man” put it, the point of rehabilitation was for each disabled veteran to become “a MAN among MEN in spite of his physical handicap.” Relying on the breadwinner ideal of manhood, those in favor of pension reform began to define disability not by a man’s missing limbs or by any other physical incapacity (as the Civil War pension system had done), but rather by his will (or lack thereof) to work. Seen this way, economic dependency—often linked overtly and metaphorically to womanliness—came to be understood as the real handicap that thwarted the full physical recovery of the veteran and the fiscal strength of the nation.
Much of what Progressive reformers knew about rehabilitation they learned from Europe. This was a time, as historian Daniel T. Rodgers tells us, when “American politics was peculiarly open to foreign models and imported ideas. Germany, France, and Great Britain first introduced rehabilitation as a way to cope, economically, morally, and militarily, with the face that millions of men had been lost to the war. Both the Allied and Central Powers instituted rehabilitation programs so that injured soldiers could be reused on the front lines and in munitions in order to meet the military and industrial demands of a totalizing war. Eventually other belligerent nations—Australia, Canada, India, and the United States—adopted programs in rehabilitation, too, in order to help their own war injured recover. Although these countries engaged in a transnational exchange of knowledge, each nation brought its own particular prewar history and culture to bear on the meaning and construction of rehabilitation. Going into the Great War, the United States was known to have the most generous veterans pension system worldwide. This fact alone makes the story of the rise of rehabilitation in the United States unique.
To make rehabilitation a reality, Woodrow Wilson appointed two internationally known and informed Progressive reformers, Judge Julian Mack and Julia Lathrop, to draw up the necessary legislation. Both Chicagoans, Mack and Lathrop moved in the same social and professional circles, networks dictated by the effort to bring about reform at the state and federal level. In July 1917, Wilson tapped Mack to help “work out a new program for compensation and aid . . . to soldiers,” one that would be “an improvement upon the traditional [Civil War] pension system.” With the help of Lathrop and Samuel Gompers, Mack drafted a complex piece of legislation that replaced the veteran pension system with government life insurance and a provision for the “rehabilitation and re-education of all disabled soldiers.” The War Risk Insurance Act, as it became known, passed Congress on October 6, 1917, without a dissenting vote.
Although rehabilitation had become law, the practicalities of how, where, and by whom it should be administered remained in question. Who should take control of the endeavor? Civilian or military leaders? Moreover, what kind of professionals should be in charge? Educators, social workers, or medical professionals? Neither Mack nor Lathrop considered the hospital to be the obvious choice. The Veterans Administration did not exist in 1917. Nor did its system of hospitals. Even in the civilian sector at the time, very few hospitals engaged in rehabilitative medicine as we have come to know it today. Put simply, the infrastructure and personnel to rehabilitate an army of injured soldiers did not exist at the time that America entered the First World War. Before the Great War, caring for maimed soldiers was largely a private matter, a community matter, a family matter, handled mostly by sisters, mothers, wives, and private charity groups.
The Army Medical Department stepped in quickly to fill the legislative requirements for rehabilitation. Within months of Wilson’s declaration of war, Army Surgeon General William C. Gorgas created the Division of Special Hospitals and Physical Reconstruction, putting a group of Boston-area orthopedic surgeons in charge. Gorgas turned to orthopedic surgeons for two reasons. First, a few of them had already begun experimenting with work and rehabilitation therapy in a handful of the nation’s children’s hospitals. Second, and more important, several orthopedists had already been involved in the rehabilitation effort abroad, assisting their colleagues in Great Britain long before the United States officially became involved in the war.
Dramatic changes took place in the Army Medical Department to accommodate the demand for rehabilitation. Because virtually every type of war wound had become defined as a disability, the Medical Department expanded to include a wide array of medical specialties. Psychiatrists, neurologists, and psychologists oversaw the rehabilitation of soldiers with neurasthenia and the newly designated diagnosis of shell shock. Ophthalmologists took charge of controlling the spread of trachoma and of providing rehabilitative care to soldiers blinded by mortar shells and poison gas. Tuberculosis specialists supervised the reconstruction of men who had acquired the tubercle bacillus during the war. And orthopedists managed fractures, amputations, and all other musculoskeletal injuries.
Rehabilitation legislation also led to the formation of entirely new, female-dominated medical subspecialties, such as occupational and physical therapy. The driving assumption behind rehabilitation was that disabled men needed to be toughened up, lest they become dependent of the state, their communities, and their families. The newly minted physical therapists engaged in this hardening process with zeal, convincing their male commanding officers that women caregivers could be forceful enough to manage, rehabilitate, and make an army of ostensibly emasculated men manly again. To that end, wartime physical therapists directed their amputee patients in “stump pounding” drills, having men with newly amputated legs walk on, thump, and pound their residual limbs. When not acting as drill sergeants, the physical therapists engaged in the arduous task of stretching and massaging limbs and backs, but only if such manual treatment elicited a degree of pain. These women adhered strictly to the “no pain, no gain” philosophy of physical training. To administer a light touch, “feel good” massage would have endangered their professional reputation (they might have been mistaken for prostitutes) while also undermining the process of remasculinization. Male rehabilitation proponents constantly reminded female physical therapists that they needed to deny their innate mothering and nurturing tendencies, for disabled soldiers required a heavy hand, not coddling.
The expansion of new medical personnel devoted to the long-term care of disabled soldiers created an unprecedented demand for hospital space. Soon after the rehabilitation legislation passed in Congress, the US Army Corps of Engineers erected hundreds of patient wards as well as entirely novel treatment areas such as massage rooms, hydrotherapy units, and electrotherapy quarters. Orthopedic appliance shops and “limb laboratories,” where physicians and staff mechanics engineered and repaired prosthetic limbs, also became a regular part of the new rehabilitation hospitals. Less than a year into the war, Walter Reed Hospital, in Washington, DC, emerged as the leading US medical facility for rehabilitation and prosthetic limb innovation, a reputation the facility still enjoys today.
The most awe-inspiring spaces of the new military rehabilitation hospitals were the “curative workshops,” wards that looked more like industrial workplaces than medical clinics. In these hospital workshops, disabled soldiers repaired automobiles, painted signs, operated telegraphs, and engaged in woodworking, all under the oversight of medical professionals who insisted that rehabilitation was at once industrial training and therapeutic agent. Although built in a time of war, a majority of these hospital facilities and personnel became a permanent part of veteran care in both army general hospitals and in the eventual Veterans Administration hospitals for the remainder of the twentieth century. Taking its cue from the military, the post–World War I civilian hospital began to construct and incorporate rehabilitation units into its system of care as well. Rehabilitation was born as a Progressive Era ideal, took shape as a military medical specialty, and eventually became a societal norm in the civilian sector.
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